Date First Written: December 2010; Date Last Updated: March 2021
Why We Do Not Have A DID Diagnosis
Introduction
A common question we get asked upon coming out as multiple, is if we have Dissociative Identity Disorder (abbreviated as DID). We decided to write down an essay detailing the twists and turns our answer to this question takes. This is because though the question seems simple the answer is a little weirder than what one might assume. Because the simple answer is "As we exist today, do not have DID as described in the DSM-5 but we used to have DID; it is just that years of therapy and self-work took us out of being diagnosable when the DSM-5 came out."
We label our existence on what has come to be labeled as being a multiple system. The definition of multiple system being when a body houses more than one separate personality/person/individual. We consider ourselves a multiple system, but we cannot and will not say that we have dissociative identity disorder in the present tense. The simple explanation for this is that none of the mental health professionals we have talked to over the years has felt the diagnosis was applicable to our situation as a multiple system considering our existence as we interacted with them at the time, but found our past symptoms would have met criteria for DID. Given we used to meet criteria for DID but no longer do thanks to years to hard work, we find it highly unlikely we will ever be diagnosed with DID unless a mental health professional goes by symptoms we once had but no longer experience.
To be clear, this essay will not cast judgment on the existence of this disorder. It is simply an explanation of our history with DID.
Therapist Response
1st Therapist Using The DSM- IV-TR
In October 2010, we finally drew up the courage to see a mental health professional after finally gaining the ability to even see a mental health professional. We wanted to get their thoughts on the state of our multiple system as well as get some help for our gender dysphoria. We had been wary of seeing someone and had been dragging our feet about it for roughly a year after fully accepting our multiplicity. So, we sat down and explained our then current experiences and our existence as a multiple system. After a few sessions of us talking non-stop about our experiences and symptoms she concluded that while our multiplicity was well apparent, she didn't think we met all the criteria for DID as described in the DSM-IV-TR. More specifically, we met all the criteria but one: we didn't have issues with time loss (anymore). We used to experience time loss to varying degrees, but we had ceased having black outs between us since achieving co-conscious a year earlier. However, she noted if we had started seeing her when we still were having issues with time loss she would have diagnosed us with DID. So, instead, she diagnosed us with DDNOS due to lacking that one criterion as that slid us into meeting DDNOS criteria instead.
Her noting our obvious multiplicity didn't mean we didn't confuse her though. The thing that confused her the most was how we had managed to work ourselves out on our own over time. She had had a few multiples as patients before and was used to it taking a lot of therapy to get all the alters to cooperate with each other to some degree. Due to this, she occasionally would slip into assuming certain things were the case for our system because that had been the case for her other patients upon them becoming her patients. She was expecting to have to start at the beginning, but we had accomplished several steps on our own, as it were. For example, at one point, she suggested that we practice mediation to quiet everything going on in our head. We had to explain to her we already did mediate on occasion and it did not affect our multiplicity in anyway. We also inquired why we would even want to try to halt our interactions together when doing so would actually cause harm if as it would hinder our communication. So, it was a bit awkward at times. Sadly, we were only able to see her a few dozen times before we had to stop going due to the co-pay being too much for our budget at the time.
2nd Therapist Using The DSM-5
In March 2015, we learned our college provided students access to a therapist for free. As we had decided we needed more help with our gender dysphoria as well wanted help with a few things related to our multiplicity, we jumped at the opportunity. So, we began our second experience with a therapist. In our first meeting, we were open to her about our multiplicity, gender dysphoria, species dysphoria, and other things about us that we wanted her to know right off the bat. Even upon the first meeting, she took our multiplicity well. After only a few sessions (and after she talked to a colleague who had some experience with dissociative identity disorder) she told us that she and her colleague had concluded that our case didn’t meet criteria for DID under the DSM-5. Our multiplicity as it was when we met her didn't fit two of the five criteria: we didn't experience time loss and we could function as a multiple system. She did state that our past states with our multiplicity would have met criteria for at least OSDD if not DID in the DSM-5.
Her acceptance of our multiplicity (even if it didn’t meet the criteria of DID) didn’t stop there though. She began to start every session by asking who was fronting. She also asked us if there was something, she could call us as a group. Her acceptance went even further then that though. She surprised us when her advice for dealing with the emotional and social frustration of being so closeted about so much was for us to come out to friends and family whom we thought would be likely to take it well. So, she began to encourage us and give us advise on coming out to the people we wanted to come out to about being multiple (and that some of us are transgender, etc.). In November 2016, we had to change therapists as it was decided we needed to go to a place where medication could be subscribed as our depression from our gender dysphoria had gotten to the point we needed to be put on an antidepressant.
3rd Therapist Using The DSM-5
So, in November 2016 we met our third therapist. Again, we explained to her about our multiplicity so she could better understand the complexity of our gender dysphoria which in turn is a major factor in our clinical depression. She also concluded we didn't fit DID under the DSM-5 due to lacking two of the criteria (lacking time loss and lacking dysfunction). Later on, we did end up talking at length about our trauma during our childhood and our struggles with our multiplicity throughout our teenagehood. This led to her also concluding that we would have met criteria for DID in the past. Regardless of our lack of being diagnosable, she still accepted our multiplicity.
She stayed our therapist up until she moved into private practice in March 2019.
4th Therapist Using The DSM-5
So, our fourth experience with a mental health professional began in April of 2019. Yet again upon us describing our past and present experiences, she commented how we were multiple but no longer met criteria for DID, but once did meet criteria. We started off by talking at length over time about our past symptoms and how in the past we qualified for DID, but it always came back to how we don't qualify going on our current state of living and being. However, despite her acceptance of our experiences, we didn't personally click with her therapy style at all (she talked 2 times more than we ever did during every session) and so we decided to find a different therapist.
5th Therapist Using The DSM-5
Our fifth experience (and as of writing this our still current experience) began in December 2019. We were upfront about our multiplicity, our past experiences throughout our life, the complexity our plurality causes in our dealing with species dysphoria and gender dysphoria (and how both have greatly impacted our clinical depression), and so on. Once again, she accepted our multiplicity and didn't find a reason to diagnose us right off the bat. Due to the COVID-19 pandemic and the lessening our dysphoria and depression due to transitioning we haven't had many appointments so haven't had a lot of time to talk more in-depth about our experiences with plurality and getting her feedback, but thus far she has accepted our plurality very easily.
DSM-5 Criteria
Criterion A (Plurality)
Criterion A for DID in the DSM-5 states, " Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual."
Our multiple system meets this Criterion in a rather solid fashion. We could argue about our disagreement that we are more than just “personality states” but nevertheless our experiences meet this criterion. Criterion A in the DSM-5 is how a doctor would describe plurality to an insurance company and we accept that. (DSM-5 talks in ways that insurance companies will understand. It's in academic books and papers where conditions and disorders are explained in detail.) Throughout our life, this criterion has continued to be met and, as never want to integrate, we will always meet this criterion.
Criterion B (Time Loss)
“Time loss,” “losing time,” or “blacking out” are all informal ways of talking about what is formally called “dissociative amnesia.” These terms describe the state in which one [alter/headmate/whatever-term-is-preferred] does not recall events during which another [alter/headmate/whatever-term-is-preferred] was in control of the body. In the DSM-5, Criterion B states, “Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.” In the DSM-5, it further describes “dissociative amnesia” as occurring in several different ways such as not being able to remember certain events in the past as well as finding evidence of having done things that one doesn’t remember doing at all. The DSM-5 also states that while the dissociative amnesia may vary from being apparent to others to being not as easily recognized, it is still present, hence why it is considered part of the criteria. The presence of amnesia has been a criterion throughout the history of dissociative identity disorder (even back when the disorder was called multiple personality disorder).
Our multiple system had only minor to mild issues with blackouts between us for much of our life prior to our adulthood. The only exception to this was a time during our teenage years were we hit heavy denial phase of our multiplicity upon first questioning it. The denial lead to us trying to quash any hint of our plurality which lead to the destruction of the trust and hair-thin connections we had that allowed us to be at least somewhat in-tune with outworld goings on. Thus, leading to roughly two years of severe time loss whenever switching occurred on top of all the other internally destructive things we caused or created by trying to “stop being plural.” However, as soon as we relented our internal assault upon ourselves once we accepted our plurality and realized we were destroying ourselves, it was relatively easy to not only regain our light memory sharing, but improve upon it over time to the point we reached co-consciousness by around the summer of 2010. Nowadays, we can easily share memories and thoughts between us at our leisure and do not have issues with not knowing what has gone on while someone else has fronted. If a therapist used our early experiences with blackouts, we would only have been given a mild case of this Criterion, but if a therapist used our system's symptoms during that specific time of our life we would certainly have met this Criterion. However, going on our experiences now, we no longer meet this Criterion.
Addendum: Now, there is the enigma that is our almost complete lack of childhood memories which we can't tell how much is normal forgetting and what might not be. However, these issues are uniform across all of us in our system and only involves memories of our childhood so we do not include it in the reasoning for Criterion B.
Criterion C (Functionality At Last)
With the publication of the DSM-5, a criterion unlike any previous version was added, Criterion C. Criterion C states, "The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” To add onto this, within the DSM-5 on page 20 it defines a disorder as, "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities." So compared to previous editions, the DSM-5 greater emphases on the experience causing harm being a required aspect for a DID diagnosis. So, if there is no distress or impairment in one's life from being multiple, then the Criterion C is not met.
Before we accepted our plurality and began to work to together to try to deal with our struggles, we certainly floundered a fair bit but our minor were relatively minor (most of the time). Of course, when we hit heavy denial of our multiplicity and tried to stop being multiple things took a turn for the worst. During that time in our life, we certainly didn't function, and we certainly experienced a "significant disturbance" during our denial phase due to our time loss, headmates undermining other headmates, and worse. However, once we accepted our multiplicity and began to build cooperation, things rather quickly improved. By the time we first saw a therapist it had been roughly a year after we accepted our multiplicity and she was rather surprised by our budding cooperation. Three years later the DSM-5 came out, and by that time we really had come a long way. So, by the time we saw of second therapist, we no longer meet this criterion.
Criterion D (Religious Complications)
Another criterion wholly new to DID without any mention in any previous editions criteria was Criterion D. Criterion D in the DSM-5 states, “The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: the symptoms are not better explained by imaginary playmates or other fantasy play.” Within the Diagnostic Features this criterion is explained further that unless the identities breach outside of the patient’s cultural and/or religious beliefs as well as cause significant distress or impairment, then it should not be labeled as DID. This criterion notes the existence of plurality within various spheres of different cultures and/or religions. It, based on what is in the DSM-5, appears to be present to help protect religious or cultural beliefs and practices (for example, in various beliefs spirit possession can be a part of the practice) from being used as evidence for having DID without taking other contexts into account.
This is another criterion where our case causes a fair amount of complications though in this case it is more of a case of different perspectives could lead to differing results rather than different timeframes in our life causing us to not always fit the criteria. It is complicated as a portion of the individuals within our body are spirits who came into our body due to our animistic inclinations as part of our general animistic and polytheistic pagan beliefs. Far from all of our multiple system are spirits, some of us are known alters formed from traumatic experiences, but the existence of spirit work and especially spirit possession in our life has caused pause to every therapist we've talked to since the DSM-5 was published. Our complicated and mixed-origins just made things weirder. Our spirit work didn't prevent a diagnosis of DID in the DSM-5 once it came out (as our therapists mostly focused on the lack of time loss and our functionality for rational there), but it did make things more confusing.
Criterion E
In the DSM-5, criterion E states “The symptoms are not attributable to the direct physiological effects […] of a substance or another medical condition […].” So this criterion works to eliminate any symptoms that could be caused by substances or another medicinal condition.
We do not take any substances that could cause any of our symptoms. On a handful of occasions medicine we were given (namely when we had our wisdom teeth removed and when we had our uterus removed) caused us to loss time, but that is the only time outside forms has affected our multiplicity.
Conclusion
What we have explained above is both the responses we have received our various mental health professionals over the years as well as giving a breakdown of our symptoms over our life in comparison to the DSM-5 criteria for DID. So, the simplest reason we cannot and will not say that we have DID is because we have not been diagnosed. We do not personally feel that the act of self-diagnosing ourselves with DID is right thing for us to do. Especially given every mental health professional we have told about our multiplicity have all concluded our symptoms, at the time of talking to them, did not meet criteria for DID as it stood in the DSM at the time of seeing them (though every one of them has noted our past symptoms fit criteria for DID within the DSM). Because of their comments, we do not find it prudent to claim something that directly goes against something they have said. Therefore, we will not claim to have DID at this time.
Our lack of being diagnosable now is a testament to how far we have come in our work toward working and living together. It doesn’t diminish the symptoms and struggles of our past. We once had DID, but we do not have it anymore.
End Notes:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Association, 2013, pages 292-298.
Bibliography:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-III. Washington, DC: American Psychiatric Association, 1980.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington, DC: American Psychiatric Association, 1994.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association, 2000.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Association, 2013.
A common question we get asked upon coming out as multiple, is if we have Dissociative Identity Disorder (abbreviated as DID). We decided to write down an essay detailing the twists and turns our answer to this question takes. This is because though the question seems simple the answer is a little weirder than what one might assume. Because the simple answer is "As we exist today, do not have DID as described in the DSM-5 but we used to have DID; it is just that years of therapy and self-work took us out of being diagnosable when the DSM-5 came out."
We label our existence on what has come to be labeled as being a multiple system. The definition of multiple system being when a body houses more than one separate personality/person/individual. We consider ourselves a multiple system, but we cannot and will not say that we have dissociative identity disorder in the present tense. The simple explanation for this is that none of the mental health professionals we have talked to over the years has felt the diagnosis was applicable to our situation as a multiple system considering our existence as we interacted with them at the time, but found our past symptoms would have met criteria for DID. Given we used to meet criteria for DID but no longer do thanks to years to hard work, we find it highly unlikely we will ever be diagnosed with DID unless a mental health professional goes by symptoms we once had but no longer experience.
To be clear, this essay will not cast judgment on the existence of this disorder. It is simply an explanation of our history with DID.
Therapist Response
1st Therapist Using The DSM- IV-TR
In October 2010, we finally drew up the courage to see a mental health professional after finally gaining the ability to even see a mental health professional. We wanted to get their thoughts on the state of our multiple system as well as get some help for our gender dysphoria. We had been wary of seeing someone and had been dragging our feet about it for roughly a year after fully accepting our multiplicity. So, we sat down and explained our then current experiences and our existence as a multiple system. After a few sessions of us talking non-stop about our experiences and symptoms she concluded that while our multiplicity was well apparent, she didn't think we met all the criteria for DID as described in the DSM-IV-TR. More specifically, we met all the criteria but one: we didn't have issues with time loss (anymore). We used to experience time loss to varying degrees, but we had ceased having black outs between us since achieving co-conscious a year earlier. However, she noted if we had started seeing her when we still were having issues with time loss she would have diagnosed us with DID. So, instead, she diagnosed us with DDNOS due to lacking that one criterion as that slid us into meeting DDNOS criteria instead.
Her noting our obvious multiplicity didn't mean we didn't confuse her though. The thing that confused her the most was how we had managed to work ourselves out on our own over time. She had had a few multiples as patients before and was used to it taking a lot of therapy to get all the alters to cooperate with each other to some degree. Due to this, she occasionally would slip into assuming certain things were the case for our system because that had been the case for her other patients upon them becoming her patients. She was expecting to have to start at the beginning, but we had accomplished several steps on our own, as it were. For example, at one point, she suggested that we practice mediation to quiet everything going on in our head. We had to explain to her we already did mediate on occasion and it did not affect our multiplicity in anyway. We also inquired why we would even want to try to halt our interactions together when doing so would actually cause harm if as it would hinder our communication. So, it was a bit awkward at times. Sadly, we were only able to see her a few dozen times before we had to stop going due to the co-pay being too much for our budget at the time.
2nd Therapist Using The DSM-5
In March 2015, we learned our college provided students access to a therapist for free. As we had decided we needed more help with our gender dysphoria as well wanted help with a few things related to our multiplicity, we jumped at the opportunity. So, we began our second experience with a therapist. In our first meeting, we were open to her about our multiplicity, gender dysphoria, species dysphoria, and other things about us that we wanted her to know right off the bat. Even upon the first meeting, she took our multiplicity well. After only a few sessions (and after she talked to a colleague who had some experience with dissociative identity disorder) she told us that she and her colleague had concluded that our case didn’t meet criteria for DID under the DSM-5. Our multiplicity as it was when we met her didn't fit two of the five criteria: we didn't experience time loss and we could function as a multiple system. She did state that our past states with our multiplicity would have met criteria for at least OSDD if not DID in the DSM-5.
Her acceptance of our multiplicity (even if it didn’t meet the criteria of DID) didn’t stop there though. She began to start every session by asking who was fronting. She also asked us if there was something, she could call us as a group. Her acceptance went even further then that though. She surprised us when her advice for dealing with the emotional and social frustration of being so closeted about so much was for us to come out to friends and family whom we thought would be likely to take it well. So, she began to encourage us and give us advise on coming out to the people we wanted to come out to about being multiple (and that some of us are transgender, etc.). In November 2016, we had to change therapists as it was decided we needed to go to a place where medication could be subscribed as our depression from our gender dysphoria had gotten to the point we needed to be put on an antidepressant.
3rd Therapist Using The DSM-5
So, in November 2016 we met our third therapist. Again, we explained to her about our multiplicity so she could better understand the complexity of our gender dysphoria which in turn is a major factor in our clinical depression. She also concluded we didn't fit DID under the DSM-5 due to lacking two of the criteria (lacking time loss and lacking dysfunction). Later on, we did end up talking at length about our trauma during our childhood and our struggles with our multiplicity throughout our teenagehood. This led to her also concluding that we would have met criteria for DID in the past. Regardless of our lack of being diagnosable, she still accepted our multiplicity.
She stayed our therapist up until she moved into private practice in March 2019.
4th Therapist Using The DSM-5
So, our fourth experience with a mental health professional began in April of 2019. Yet again upon us describing our past and present experiences, she commented how we were multiple but no longer met criteria for DID, but once did meet criteria. We started off by talking at length over time about our past symptoms and how in the past we qualified for DID, but it always came back to how we don't qualify going on our current state of living and being. However, despite her acceptance of our experiences, we didn't personally click with her therapy style at all (she talked 2 times more than we ever did during every session) and so we decided to find a different therapist.
5th Therapist Using The DSM-5
Our fifth experience (and as of writing this our still current experience) began in December 2019. We were upfront about our multiplicity, our past experiences throughout our life, the complexity our plurality causes in our dealing with species dysphoria and gender dysphoria (and how both have greatly impacted our clinical depression), and so on. Once again, she accepted our multiplicity and didn't find a reason to diagnose us right off the bat. Due to the COVID-19 pandemic and the lessening our dysphoria and depression due to transitioning we haven't had many appointments so haven't had a lot of time to talk more in-depth about our experiences with plurality and getting her feedback, but thus far she has accepted our plurality very easily.
DSM-5 Criteria
Criterion A (Plurality)
Criterion A for DID in the DSM-5 states, " Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual."
Our multiple system meets this Criterion in a rather solid fashion. We could argue about our disagreement that we are more than just “personality states” but nevertheless our experiences meet this criterion. Criterion A in the DSM-5 is how a doctor would describe plurality to an insurance company and we accept that. (DSM-5 talks in ways that insurance companies will understand. It's in academic books and papers where conditions and disorders are explained in detail.) Throughout our life, this criterion has continued to be met and, as never want to integrate, we will always meet this criterion.
Criterion B (Time Loss)
“Time loss,” “losing time,” or “blacking out” are all informal ways of talking about what is formally called “dissociative amnesia.” These terms describe the state in which one [alter/headmate/whatever-term-is-preferred] does not recall events during which another [alter/headmate/whatever-term-is-preferred] was in control of the body. In the DSM-5, Criterion B states, “Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.” In the DSM-5, it further describes “dissociative amnesia” as occurring in several different ways such as not being able to remember certain events in the past as well as finding evidence of having done things that one doesn’t remember doing at all. The DSM-5 also states that while the dissociative amnesia may vary from being apparent to others to being not as easily recognized, it is still present, hence why it is considered part of the criteria. The presence of amnesia has been a criterion throughout the history of dissociative identity disorder (even back when the disorder was called multiple personality disorder).
Our multiple system had only minor to mild issues with blackouts between us for much of our life prior to our adulthood. The only exception to this was a time during our teenage years were we hit heavy denial phase of our multiplicity upon first questioning it. The denial lead to us trying to quash any hint of our plurality which lead to the destruction of the trust and hair-thin connections we had that allowed us to be at least somewhat in-tune with outworld goings on. Thus, leading to roughly two years of severe time loss whenever switching occurred on top of all the other internally destructive things we caused or created by trying to “stop being plural.” However, as soon as we relented our internal assault upon ourselves once we accepted our plurality and realized we were destroying ourselves, it was relatively easy to not only regain our light memory sharing, but improve upon it over time to the point we reached co-consciousness by around the summer of 2010. Nowadays, we can easily share memories and thoughts between us at our leisure and do not have issues with not knowing what has gone on while someone else has fronted. If a therapist used our early experiences with blackouts, we would only have been given a mild case of this Criterion, but if a therapist used our system's symptoms during that specific time of our life we would certainly have met this Criterion. However, going on our experiences now, we no longer meet this Criterion.
Addendum: Now, there is the enigma that is our almost complete lack of childhood memories which we can't tell how much is normal forgetting and what might not be. However, these issues are uniform across all of us in our system and only involves memories of our childhood so we do not include it in the reasoning for Criterion B.
Criterion C (Functionality At Last)
With the publication of the DSM-5, a criterion unlike any previous version was added, Criterion C. Criterion C states, "The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.” To add onto this, within the DSM-5 on page 20 it defines a disorder as, "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities." So compared to previous editions, the DSM-5 greater emphases on the experience causing harm being a required aspect for a DID diagnosis. So, if there is no distress or impairment in one's life from being multiple, then the Criterion C is not met.
Before we accepted our plurality and began to work to together to try to deal with our struggles, we certainly floundered a fair bit but our minor were relatively minor (most of the time). Of course, when we hit heavy denial of our multiplicity and tried to stop being multiple things took a turn for the worst. During that time in our life, we certainly didn't function, and we certainly experienced a "significant disturbance" during our denial phase due to our time loss, headmates undermining other headmates, and worse. However, once we accepted our multiplicity and began to build cooperation, things rather quickly improved. By the time we first saw a therapist it had been roughly a year after we accepted our multiplicity and she was rather surprised by our budding cooperation. Three years later the DSM-5 came out, and by that time we really had come a long way. So, by the time we saw of second therapist, we no longer meet this criterion.
Criterion D (Religious Complications)
Another criterion wholly new to DID without any mention in any previous editions criteria was Criterion D. Criterion D in the DSM-5 states, “The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: the symptoms are not better explained by imaginary playmates or other fantasy play.” Within the Diagnostic Features this criterion is explained further that unless the identities breach outside of the patient’s cultural and/or religious beliefs as well as cause significant distress or impairment, then it should not be labeled as DID. This criterion notes the existence of plurality within various spheres of different cultures and/or religions. It, based on what is in the DSM-5, appears to be present to help protect religious or cultural beliefs and practices (for example, in various beliefs spirit possession can be a part of the practice) from being used as evidence for having DID without taking other contexts into account.
This is another criterion where our case causes a fair amount of complications though in this case it is more of a case of different perspectives could lead to differing results rather than different timeframes in our life causing us to not always fit the criteria. It is complicated as a portion of the individuals within our body are spirits who came into our body due to our animistic inclinations as part of our general animistic and polytheistic pagan beliefs. Far from all of our multiple system are spirits, some of us are known alters formed from traumatic experiences, but the existence of spirit work and especially spirit possession in our life has caused pause to every therapist we've talked to since the DSM-5 was published. Our complicated and mixed-origins just made things weirder. Our spirit work didn't prevent a diagnosis of DID in the DSM-5 once it came out (as our therapists mostly focused on the lack of time loss and our functionality for rational there), but it did make things more confusing.
Criterion E
In the DSM-5, criterion E states “The symptoms are not attributable to the direct physiological effects […] of a substance or another medical condition […].” So this criterion works to eliminate any symptoms that could be caused by substances or another medicinal condition.
We do not take any substances that could cause any of our symptoms. On a handful of occasions medicine we were given (namely when we had our wisdom teeth removed and when we had our uterus removed) caused us to loss time, but that is the only time outside forms has affected our multiplicity.
Conclusion
What we have explained above is both the responses we have received our various mental health professionals over the years as well as giving a breakdown of our symptoms over our life in comparison to the DSM-5 criteria for DID. So, the simplest reason we cannot and will not say that we have DID is because we have not been diagnosed. We do not personally feel that the act of self-diagnosing ourselves with DID is right thing for us to do. Especially given every mental health professional we have told about our multiplicity have all concluded our symptoms, at the time of talking to them, did not meet criteria for DID as it stood in the DSM at the time of seeing them (though every one of them has noted our past symptoms fit criteria for DID within the DSM). Because of their comments, we do not find it prudent to claim something that directly goes against something they have said. Therefore, we will not claim to have DID at this time.
Our lack of being diagnosable now is a testament to how far we have come in our work toward working and living together. It doesn’t diminish the symptoms and struggles of our past. We once had DID, but we do not have it anymore.
End Notes:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Association, 2013, pages 292-298.
Bibliography:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-III. Washington, DC: American Psychiatric Association, 1980.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington, DC: American Psychiatric Association, 1994.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association, 2000.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Association, 2013.